Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial
Molenaar CJL · Minnella EM · Coca-Martinez M · Ten Cate DWG · Regis M · Awasthi R · Martínez-Palli G · López-Baamonde M · Sebio-Garcia R · Feo CV · van Rooijen SJ · Schreinemakers JMJ · Bojesen RD · Gögenur I · van den Heuvel ER · Carli F · Slooter GD · PREHAB Study Group
JAMA Surgery · 2023
What the research tells us
In PREHAB, four weeks of multimodal prehabilitation was associated with fewer severe complications, defined as CCI>20: 21/123 versus 38/128, adjusted OR=.47 (95% CI .26–.87). The other coprimary outcome, six-minute walk distance four weeks after surgery, differed by 15.6 m (−1.4 to 32.6), which was not significant. These outcomes require separate interpretation.
Scope & interpretation
The planned sample was 714, but COVID-19 stopped recruitment early. CCI was analysed dichotomously because of skew, and about one-third of four-week walking data were missing. A 2023 correction added significance superscripts to the prehabilitation group's preoperative and four-week Figure 3D data. Eight-week secondary results do not replace the four-week coprimary endpoint.
Study at a glance
- POPULATION & SAMPLE
- Seven centres and nonmetastatic colorectal-cancer surgery patients; 269 randomized, 18 excluded after randomization and 251 in the authors' intention-to-treat analysis. Median age was 69.
- EXPOSURE / INTERVENTION / SUBJECT
- Four weeks of supervised exercise, nutrition and psychological support with standard enhanced recovery, versus standard care.
- OUTCOMES
- Coprimary 30-day CCI and four-week walk distance; continuous CCI comparison P=.06. Seven minor and no serious intervention-related adverse events were reported.
- TIME FRAME
- Four preoperative weeks; primary postoperative assessments at 30 days and four weeks, with later measurements.
Editorial & review record
Record for v1.0 · Updated
Editorial responsibility: TAP Editorial Team
Scientific review
Not yet scientifically reviewed
Editorial note
Under the editorial responsibility of the TAP Editorial Team, this publication used AI assistance for content organization and editing. Scientific review is recorded separately on this page.
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How responsibilities and review are recorded ↗Scope of this reading note
Original PDF body and formal correction of 3 May 2023. The consulted PDF predates the correction, so Figure 3D must be read with the notice. Protocol, statistical analysis plan and all missing-data sensitivity supplements remain to be checked.
- Study funding
- Dutch Cancer Society and Johnson & Johnson, among others; protein supplied by FrieslandCampina and Immunotec, equipment loaned by Philips.
- Competing interests
- Some authors disclosed relationships with Dompé, Pharmacosmos, Intuitive and Ethicon, among others. Funders reportedly had no role in research decisions.
Project support
Founded and supported by Resilio.
Revision history
- · v1.0
Added PREHAB with separate coprimary results and the Figure 3D correction.